Okpani Arnold I, Abimbola Seye
1London School of Hygiene and Tropical Medicine, London, United Kingdom.
2National Primary Health Care Development Agency, Plot 681/682, Port-Harcourt Crescent, Area 11, Garki, Abuja, FCT Nigeria.
Glob Health Res Policy. 2016 Oct 24;1:16. doi: 10.1186/s41256-016-0017-4. eCollection 2016.
The federal government of Nigeria started the Midwives Service Scheme in 2009 to address the scarcity of skilled health workers in rural communities by temporarily redistributing midwives from urban to rural communities. The scheme was designed as a collaboration among federal, state and local governments. Six years on, this study examines the contextual factors that account for the differences in performance of the scheme in Benue and Kogi, two contiguous states in central Nigeria.
We obtained qualitative data through 14 in-depth interviews and 2 focus group discussions: 14 government officials at the federal, state and local government levels were interviewed to explore their perceptions on the design, implementation and sustainability of the Midwives Service Scheme. In addition, mothers in rural communities participated in 2 focus group discussions (one in each state) to elicit their views on Midwives Service Scheme services. The qualitative data were analysed for themes.
The inability of the federal government to substantially influence the health care agenda of sub-national governments was a significant impediment to the achievement of the objectives of the Midwives Service Scheme. Participants identified differences in government prioritisation of primary health care between Benue and Kogi as relevant to maternal and child health outcomes in those states: Kogi was far more supportive of the Midwives Service Scheme and primary health care more broadly. High user fees in Benue was a significant barrier to the uptake of available maternal and child health services.
Differential levels of political support and prioritisation, alongside financial barriers, contribute substantially to the uptake of maternal and child health services. For collaborative health sector strategies to gain sufficient traction, where federating units determine their health care priorities, they must be accompanied by strong and enforceable commitment by sub-national governments.
尼日利亚联邦政府于2009年启动了助产士服务计划，通过将城市助产士临时重新分配到农村社区，来解决农村社区熟练卫生工作者短缺的问题。该计划旨在作为联邦、州和地方政府之间的合作项目。六年过去了，本研究考察了导致该计划在尼日利亚中部两个相邻州——贝努埃州和科吉州——实施效果存在差异的背景因素。
我们通过14次深入访谈和2次焦点小组讨论获取了定性数据：采访了14名联邦、州和地方政府层面的政府官员，以探讨他们对助产士服务计划的设计、实施和可持续性的看法。此外，农村社区的母亲们参加了2次焦点小组讨论（每个州各一次），以了解她们对助产士服务计划服务的看法。对定性数据进行了主题分析。
联邦政府无法实质性地影响地方政府的医疗议程，这是实现助产士服务计划目标的重大障碍。参与者指出，贝努埃州和科吉州在政府对初级卫生保健的优先排序上存在差异，这与这些州的母婴健康结果相关：科吉州对助产士服务计划以及更广泛的初级卫生保健的支持力度要大得多。贝努埃州高昂的使用者费用是获得现有母婴健康服务的重大障碍。
政治支持和优先排序的不同水平，以及经济障碍，在很大程度上影响了母婴健康服务的获取。对于联合卫生部门战略要获得足够的影响力，在联邦成员单位确定其医疗保健优先事项的情况下，必须有地方政府强有力且可执行的承诺。
